Unfallchirurg 

About: Unfallchirurg is an academic journal published by Springer Science+Business Media. The journal publishes majorly in the area(s): Hand surgery & Fracture fixation. It has an ISSN identifier of 0177-5537. Over the lifetime, 7246 publications have been published receiving 63029 citations.

Vacuum sealing as treatment of soft tissue damage in open fractures

Abstract: In 1992, 15 of 152 patients with open fractures were treated with vacuum sealing Drainage tubes are inserted into polyvinyl foam, which is used to fill in the wound or tissue defect Polyvinyl foam and adjacent skin are covered with a transparent polyurethane dressing which is impermeable to bacteria The connection of the drainage tubes to a suction device, such as vacuum bottles, produces negative pressure in the polyvinyl foam, which means a high-contact zone of the foam-wound interface This results in efficient cleaning and conditioning of the wound, with marked proliferation of granulation tissue Bone infection did not occur in any of our 15 patients; 1 patient sustained a soft tissue infection due to an insufficient sealing technique When the correct technique was applied the infection cleared up

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF)

Abstract: ,,Die AWMF ber~it fiber grunds~itzliche und fachfibergreifende Angelegenheiten und Aufgaben, erarbeitet Empfehlungen und Resolutionen und vertritt diese gegenfiber den damit befal3ten Institutionen, insbesondere auch im politischen Raum. Neben denangesichts der zunehmenden Spezialisierung immer dringenderen Aufgaben der inneren Zusammenarbeit will sie damit die Interessen der medizinischen Wissenschaft verst~trkt nach aul3en zur Geltung bringen.

Die schwere Beckenverletzung mit pelviner Massenblutung : Ermittlung der Blutungsschwere und klinische Erfahrung mit der Notfallstabilisierung

Abstract: The blood loss during the acute period after complex pelvic trauma is finally responsible for the high mortality associated with this specific type of injury. Several protocols have been published for optimized management, but up to now comparable data are not available as no exact definitions exist judging the severity of trauma and blood loss. As part of a prospective study 19 patients after unstable pelvic injuries with unstable circulation underwent emergency stabilization by the pelvic C-clamp. Beside standard clinical parameter the initial hemoglobin value was converted into a "blood volume equivalent". 18 of the 19 patients had an injury severity according to group III and IV of the Hannover Polytrauma Score (PTS). Concommitant abdominal injuries were seen in 12 cases (23 injuries), concommitant urological injuries in 12 cases (14 injuries). In 13 cases the pelvis was the major source of bleeding in 9 cases an additional intraabdominal hemorrhage was observed. 11 patients died due to sequelae of their injury, 8 patients survived. Although the initial blood loss was comparable both in the group of the deceased patients and the survivors, a 44% higher subsequent blood substitution (= 10089 ml) was observed in the nonsurvivor group. In conclusion the data proofed that early control of hemorrhage is fundamental for the prognoses after complex pelvic trauma. The estimation of the blood loss may help in indicating aggressive emergency procedures like emergency stabilisation, pelvic clamps, surgical exploration and tamponade. This calculation may be a basis for a more detailed analyses of this devastating injury and judging the benefit of different management protocols.

[Pelvic fractures: epidemiology, therapy and long-term outcome. Overview of the multicenter study of the Pelvis Study Group]

Abstract: Pelvic fractures are rare injuries (3-8%) when compared to fractures in other body regions. They are accompanied by high mortality (5-20%), and the survivors suffer from severe pain and pelvic-related handicaps. The German Pelvic Group (German Chapter of the AO-International & German Trauma Society) started a prospective multicenter study, including ten major trauma centers for collecting a high number of data in a short period of time (1991-1993). All pelvic injuries were documented consecutively using a special set of evaluation sheets. The study closed with 1,722 patients. A 2-year follow-up was completed for 486 patients injured in 1991 and 1992 after type B and C injuries, complex pelvic trauma, acetabulum fractures and a random 25% of A-type injuries (overall follow-up rate 73%). The follow-up included special "out-come" criteria. Of the pelvic ring injuries without significant peripelvic soft tissue involvement, 63.6% were A-type fractures, 21.0% B-type injuries and 15.5% C-type injuries. The rate of operative stabilization was 3.9% after A-type injuries, 37.3% after B-type injuries and 54.3% after C-type injuries. In isolated acetabular fractures ORIF was performed in 38.6%. The total lethality was 7.9% with a significant difference between "complex" pelvic trauma (21.3%) and patients without concomitant peripelvic injuries (7.2%). In 0.9% the pelvic injury was reported as the main cause of death. Pain at follow-up was observed in every classification group, the rate of completely "pain-free" patients being 55% after A-type, 41% after B-type and 27% after C-type fractures. Malfunction of micturia was reported by 7.6% of all patients, sexual malfunction by 11.6% of the males ("erectile dysfunction") and 2.2% of the female ("dysparneuria"). Scaled by the recently developed "outcome score", the radiological result showed anatomical healing after 90.8% of the B-type and 74.6% of the C-type injuries. On the other hand, the clinical result was rated as good or excellent in only 70% of the B-type and 54% of the C-type injuries. Although progress in indications and treatment techniques has shown improved radiological results after unstable pelvic ring injuries when compared to earlier studies, the clinical result still remains unsatisfactory. Further analyses and studies must be conducted to identify the prognostic factors for the late sequelae. Whether it is possible influence these factors by additional surgical intervention cannot be answered at present.

Fractures of the distal humerus

Abstract: The treatment of fractures of the distal humerus remains challenging due to the complex anatomy of the elbow joint. Satisfactory results can only be attained with the complete recovery of the function and stability of the joint. Open reduction and internal fixation following AO principles, therefore, represents the standard procedure for the treatment of distal humerus fractures. Unfavourable results can, however, not be avoided in all cases, especially if fractures are complicated by concomitant lesions of soft tissues, nerves or vessels.